Depression and Men

About this leaflet

Men seem to suffer from
depression just as often as women, but they are less likely to ask
for help. This leaflet gives some basic facts about depression,
how it can affect men, and how to get
help.

Why is it
important?

Depression can be very
unpleasant and is a major reason for people taking time off
work. Many - perhaps most - men who kill themselves have been
depressed – so it can even be fatal. However, depression can be
helped - the sooner the better.

What's the difference between
just feeling miserable and being depressed?

Everyone has times in their
lives when they feel down or depressed. It is usually for a good
reason, does not dominate your life and does not last for a long
time.

However, if the depression
goes on for weeks, months, or becomes very bad, you may find
yourself stuck and unable to lift yourself out of it. It can start
to affect every area of your life - and this is when you may need
to get help. Depression is not a sign of weakness - it has affected
many famous and successful men.

What about bipolar disorder (manic depression)?

Some people have severe
depression - but also times when they become elated and
over-active. These 'high' periods can be just as harmful as the
periods of depression. This used to be called manic
depression, but is now bipolar
disorder.

What are the signs of
depression?

If you are depressed, you
will probably notice some of the following:

In your mind, you:

feel
unhappy, miserable, down, depressed. The feeling just
won’t go away and can be worse at a particular time of day, often
first thing in the morning

stop looking after your home properly - you stop cooking, don't
tidy, forget to change the sheets on your bed.

Anxiety

Some men also feel very anxious when they become depressed. You
feel on edge all the time, worried, fearful, and may find it hard
to go out or to face people. Anxiety can often also
cause physical symptoms - dry mouth, sweating, shakiness,
palpitations, breathlessness, stomach churning and diarrhoea.

Is depression
really different for men?

Different symptoms

There doesn't seem to
be a completely separate type of ‘male depression’. However,
some symptoms are more common in men than in women. These
include:

irritability

sudden
anger

increased
loss of control

greater
risk-taking

aggression.

Men are also more likely to
commit suicide.

Different ways of coping

Men are diagnosed with depression less than women, but do seem
to drink and use illegal drugs more heavily than women. It may be
that, instead of talking, men use drugs and alcohol as
'self-medication' to cope with their depression.

Men’s attitudes and
behaviour

Attitudes

Some men are
particularly competitive and concerned with power and success. If
you are like this, it may be harder to tell someone that you feel
fragile or that you need help. You may feel strongly that you have
to do it on your own.

You may also worry that if
you do talk to your partner - or anyone else - about how you feel,
they will not be sympathetic.

These attitudes can stop you from talking to your loved ones and
doctors about how you're feeling - so you don't get the help that
you need.

Personality

Shy men seem to be more likely to become depressed.

However, depression can happen to anyone, even powerful
personalities. Winston Churchill called it "his black dog".

Behaviour

Instead of talking about how you
feel, you may use alcohol or drugs to feel better. This usually
makes things worse, certainly in the long run. Your work will
suffer and alcohol often leads to irresponsible, unpleasant or
dangerous behaviour.

You may also focus more on your work
than your relationships or home life. This can cause conflicts with
your wife or partners.

What makes men depressed?

Relationships

Trouble in a marriage or
important relationship is the single thing most likely to make you
depressed.

Communication style

A difference in
communication 'style' can be a problem, particularly between a man
and a woman. If a disagreement or argument makes you feel
uncomfortable, you may just try not to talk about it. But if your
partner still wants to discuss it, they can feel ignored. When they
try to get you to talk about it, you feel nagged and will tend to
withdraw further which can make your partner feel even more
ignored.

Separation and
divorce

Men have traditionally seen
themselves as being in charge of their families’ lives.
However, women are more likely to start the process of separation
and divorce.

Depression is more common
and more severe in men who are divorced. This may be because, as
well as losing your main relationship:

you often lose touch
with your children

you may have to move
to live in a different place

you often find
yourself short of money.

Pregnancy and
children

We have known for many
years that some mothers become depressed after having a baby.
We now know that more than 1 in 10 fathers also have problems at
that time.

This shouldn't really be
surprising. We know that major events in people's lives, even good
ones like moving house, can make you depressed. And becoming a
parent will change your life more than almost any other thing.
Suddenly, you have to spend much more of your time looking after
your partner, and possibly other children. You may get very
tired.

A new mother will tend to be less interested in sex for a
number of months. Simple tiredness is the main problem, although
it's easy to take it personally and feel that you are being
rejected.

You may have to adjust, perhaps for the first time, to taking
second place in your partner's affections.

You may have to re-balance
the demands of home and work - there's a lot more to do at home and
you just can't spend so much time at work.

A new father is more likely to become depressed if his partner
is depressed, if he isn't getting on with his partner, or if he is
unemployed.

If you get depressed at this time, it will affect your
partner..

Work, unemployment and
retirement

Work

Work can be stressful. If
your work makes you depressed, you won't be able to cope as
well. Which makes you feel worse and less able to cope ...
which makes you feel even worse.

Unemployment

After relationship difficulties, unemployment is the thing most
likely to push a man into a serious depression. Research has
shown that up to 1 in 7 men who become unemployed will develop a
depressive illness in the next 6 months.

Your work may be a large part of what makes you feel good about
yourself. If you lose your job, you may lose other things
that are important to you, such as a company car. It can be hard to
adjust to being at home and looking after the children while your
wife or partner becomes the bread-winner.

From a position of being in control, you may face a future over
which you have little control, especially if it takes a long time
to find another job. And depression itself can make it harder to
get another job.

Retirement

You may even find it hard if you retire at the usual time,
especially if your partner carries on working. Although life may be
less stressful, you may miss the structure of your day, your social
life with colleagues and the sense that you make a difference.

What other problems can depression cause?

Problems with
sex

When men are depressed, they feel
less good about their bodies and less sexy. Many go off sex
completely.

Some men who are depressed have
intercourse just as often, but they don't feel as satisfied as
usual.

A few depressed men seem to have sex
more often, perhaps as a way of trying to make themselves feel
better.

The good news is that, as the
depression improves, your sexual desire, performance and
satisfaction will return.

It's worth remembering that it can
happen the other way round. Impotence (difficulty in getting or
keeping an erection) can bring about depression. Again, there are
effective ways to help this.

Suicide

Men are around 3 times more
likely to kill themselves than women.

Suicide is commonest among
men who are separated, widowed or divorced.

It is more likely if you
drink heavily.

Talking helps. If you feel
so bad that you have thought about suicide, it can be a relief to
talk about it.

If you're worried that a man you know might be suicidal

Even if he is not very good at talking about how he is feeling,
it is important to ask if you have any suspicion - and to take him
seriously.

For a man who feels suicidal, there is nothing more demoralising
than to feel that others do not take him seriously. He will often
have taken some time to pluck up the courage to tell anyone about
it.

If you ask a man if he is feeling suicidal, you will
not put the idea into his head or make it more
likely that he will kill himself.

Helping men

Many men find it difficult
to ask for help when they are depressed. It can help to see
depression as a result of chemical changes in the brain and/or as
the result of living in a demanding and stressful world. It
is nothing to do with being weak or having failed.

Men can get help more
easily if people recognise their particular needs. For instance, a
man who is depressed is more likely to talk about his physical
symptoms than his feelings. This may be one reason why
doctors sometimes don't recognise depression in men.

If a depressed man is in a
steady relationship, his partner should usually be involved. They
need to understand what is happening.

Helping
yourself

Talk to
someone – if you’ve had a major upset in your life,
don't bottle things up. Try to tell someone how you feel about it.
If you don't feel you can talk to anyone, try writing down how you
feel.

Keep active
– get out of doors and take some exercise, even if it’s
only a walk during your lunch-break at work. This will help to keep
you physically fit and sleep better. It can also help you not to
dwell on painful thoughts and feelings.

Eat properly
– you may not feel very hungry, but you try
to eat a balanced diet, with lots of fruit and vegetables.
It’s easy to lose weight and run low on vitamins when you are
depressed - or to eat too much junk food and put on weight you
don't want.

Avoid alcohol and
drugs – alcohol can make you feel better for a
couple of hours, but it will make you more depressed in the long
run. The same goes for street drugs, particularly amphetamines,
cocaine and ecstasy.

Don’t get upset if
you can’t sleep – do something restful that you enjoy,
like listening to the radio or watching television. If you feel
tense all the time, try exercise, yoga, massage, aromatherapy
etc.

Do something you
enjoy – take some regular time to do something you really
enjoy – exercise, reading, a hobby.

Check out your
lifestyle – you may be a perfectionist who
drives yourself too hard. Try to set yourself more realistic
targets and reduce your workload. You may need to be kinder to
yourself.

Take a break
– it can be really helpful to get away and out of your
normal routine for a few days. Even a few hours can be
helpful.

Read about
depression – there are now many books and websites about
depression. They help you to cope and also help friends and
relatives to understand what you are going through.

Join a support
group - it can be hard to help yourself when you're
depressed. Talking with other men in a similar situation can help.
Have a look at the list of organisations at the end of this
leaflet.

How do I get
help?

Depression
can be as much an illness as pneumonia or breaking your leg. Don't
feel embarassed or ashamed about it. The most important thing
is to ask for the help you need, when you need it.

Go to your GP

Try to find a doctor in the practice that you feel comfortable
with, and who you can see regularly.

What about confidentiality?

You may be concerned about the information in your medical
records. Will it damage your chances at work if your doctor
has to mention it in a report? In the UK, the Disability
Discrimination Act means that it is illegal for an employer to fire
you - or not hire you - just because you have a certain
diagnosis. They can only refuse you a job if your condition
(whatever it is) will actually interfere with your ability to do
the job. Even if it does interfere to some extent, an
employer is expected to make reasonable adjustments to ensure that
you can be supported in your job.

What will my GP do?

Depending on how bad you feel, your circumstances and whether
you have physical symptoms, your GP may suggest:

You may not like the idea of talking to someone or having
psychotherapy.
You may not like the idea of taking antidepressant medication.
However, both can help depression. You may find it hard to work out
what's right for you when you are feeling down. Talk it
through with your friends and family, and your doctor.

You can find out more information on treatment in our main
leaflet on depression.

Your GP can also give you a proper physical check-up. This
is because some physical illnesses can cause depression. If you are
already having treatment for a physical illness, your GP will need
to know about it.

If you need more information, or want to talk to somebody
confidentially, have a look at the publications and other
organisations listed below.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT for short) can be used:

in severe depression, if the person's life is at risk and they
need urgent treatment

in moderate or severe depression, when no other treatment has
helped.

ECT involves passing an electric current
through the brain, so is always given in hospital under general
anaesthetic. Some people have memory problems after ECT. See
our leaflet on ECT for more
information.

Finally, keep
hopeful:

it may be hard to believe, but you will feel better;

some people come out of depression stronger than they were
before. You may find that you see situations and
relationships more clearly than before;

some people continue to have periods of depression but learn to
live with them;

remember that depression is common, it can be helped and you
are entitled to the help you need.

Further reading

Reading
Well Agency: Books on PrescriptionReading Well Books on
Prescription helps you manage your well-being using self-help
reading. The scheme is endorsed by health professionals, including
the Royal College of Psychiatrists, and is supported by public
libraries.

Warner J et al. Rates and
predictors of mental illness in gay men, lesbians and bisexual men
and women: results from a survey based in England and Wales. The
British Journal of Psychiatry (2004) 185: 479-485.

Produced by the Royal College of Psychiatrists' Public
Education Editorial Board.
Series Editor: Dr Philip Timms

Expert: Dr David Baldwin

Service user/carer input: Depression Alliance and members of
the RCPsych Service User Forum.